| NPI | 1619966058 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01068276A)  | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101261638)  | 
| 207Q00000X Family Medicine (Licence: MI 4301104697)  | |
| 207Q00000X Family Medicine (Licence: RI MD16478)  | |
| 207Q00000X Family Medicine (Licence: IL 036161665)  | |
| 207Q00000X Family Medicine (Licence: AR E-11879)  | |
| 207Q00000X Family Medicine (Licence: GA 081939)  | |
| 207Q00000X Family Medicine (Licence: CA C159538)  | |
| Enumeration Date | 2005-10-18 | 
| Last Update Date | 2025-02-11 |